ANAPHYLACTOID REACTIONS WITH INTRAPERITONEAL CISPLATIN

OBJECTIVE: To report the occurrence of anaphylactoid reactions to intr aperitoneal cisplatin in 3 patients. CASE SUMMARIES: While conducting a protocol evaluating the efficacy of intraperitoneal cisplatin and hy perthermia in the treatment of recurrent ovarian cancer, 3 patients we re noted to exhibit anaphylactoid reactions. A 43-year-oId woman recei ved cisplatin 60 mg/m(2) in 15 minutes during her sixth cycle of thera py. She developed pruritus, edema, and urticaria over both hands. The reaction subsided after treatment with diphenhydramine and dexamethaso ne. A 57-year-old woman received 400 mL (62.4 mg) of a cisplatin solut ion concentrated to deliver cisplatin 100 mg/m(2) during her first att empted therapy. At this point, she developed whole body urticaria and pruritus with edema of the extremities. The reaction was aborted with diphenhydramine and dexamethasone. Despite premedication with dexameth asone prior to a second attempt at therapy, she again experienced simi lar symptoms after receiving 500 mL (78 mg) of cisplatin solution. A 5 5-year-old woman received 2 cycles of therapy with cisplatin 100 mg/m( 2) without difficulty. During her third cycle, she again received cisp latin 100 mg/m(2) over 30 minutes and developed palmar pruritus, urtic aria, and edema. Symptomatology resolved with diphenhydramine. Despite premedication with diphenhydramine and dexamethasone, she experienced generalized pruritus and urticaria, as well as headache and chest pai n/tightness, after her next infusion. For both the second and third pa tients, symptomatology failed to resolve until the intraperitoneal cis platin solution was withdrawn. DISCUSSION: Anaphylactoid reactions hav e been described previously with cisplatin administration. No dose-rat e effect has been reported, however. We observed 5 reactions in 3 pati ents that appear to be related to a high dose-infusion time ratio, ind icating that dose and rate of infusion may be important factors in pre cipitating anaphylactoid reactions with cisplatin. CONCLUSIONS: We con clude that a high dose combined with a short infusion time increases t he risk of anaphylactoid reactions with the administration of intraper itoneal cisplatin. There was no indication that the increase in anaphy lactoid reactions was associated with the use of hyperthermia.